I’m going to date myself a bit here. For my childhood, there were two players that I admired: “The Ryan Express” Nolan Ryan and “The Mailman” Karl Malone. And no, I’m not referencing when Nolan locked Robin Ventura in a headlock after he rushed the mound and started pounding on him (although sometimes we may feel we need to do that for our patients 😊). One of the elements that made these two greats stand out was their rituals.
Karl Malone—everyone knew he would set his feet, dribble the ball, spin it, and mutter a phrase (most often reported as, “This is for my family”) before shooting. Nolan Ryan wasn’t known for a flashy ritual, but he was relentlessly consistent in what he did prior to each pitch. He was even known to mentally visualize how he planned to approach each batter.
These aren’t the only athletes with rituals and routines. I see it from five-year-olds mimicking the greats, to high schoolers, college players, and pros. So why do I care—or even mention it? Athletes aren’t just quirky or superstitious (okay, most are superstitious, but I won’t go there 😊). Whether they realize it or not, these athletes are practicing a form of mental rehearsal that neuroscience tells us enhances focus, consistency, and performance.
Even though Nolan Ryan’s rituals weren’t theatrical, his consistency—deep breath, identical windup, intense eye contact—became his signature. He recalled his prior visualizations, controlled his tempo, and approached each pitch with fierce mental clarity. This discipline didn’t just make him intimidating—it made him enduring.
This kind of repeatable, intentional behavior creates predictability under pressure. For those of us who provide sedation and/or anesthesia, this should sound familiar. Every case has variation, but the act of initiating sedation—just like a free throw or a pitch—benefits from a practiced and familiar ritual.
Studies in cognitive psychology support this: pre-performance routines reduce anxiety, increase confidence, and narrow attentional focus (Cotterill, 2010; Mesagno & Mullane-Grant, 2010). In surgical and sedation settings, where errors of omission can have real consequences, that kind of focus is paramount.
Implementing a reliable pre-sedation checklist and operatory/environmental check acts like a mental and procedural “warm-up.” Over time, the body and brain expect it, rely on it, and perform better because of it.
At Xchart, we’ve built this principle into every aspect of our sedation/anesthesia documentation and workflow—checklists within checklists, and prompts that promote safety rituals. Our aim is to give providers the same mental edge Karl Malone had at the line or Nolan Ryan had on the mound.
Because in anesthesia and sedation, that’s the kind of performance you need—every time.
As always, stay paperless my friends!
- Travis V. Coulter, DDS